Provider Demographics
NPI:1477703494
Name:KRAKOW, SAMUEL LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LOUIS
Last Name:KRAKOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3836 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2811
Mailing Address - Country:US
Mailing Address - Phone:610-547-9081
Mailing Address - Fax:
Practice Address - Street 1:3836 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2811
Practice Address - Country:US
Practice Address - Phone:610-547-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine